GI Flashcards
1
Q
Name the four quadrants of the abdomen.
A
Right upper
Left upper
Right lower
Left lower
2
Q
What lines divide the abdomen into the 4 quadrants?
A
Transumbilical line and median line
3
Q
What are the 9 regions of the abdomen?
A
Right hypochondriac Epigastric Left hypochondriac Right lumbar Umbilical Left lumbar Right iliac fossa Suprapubic Left iliac fossa
4
Q
What lines are used to divide the abdomen into 9 regions?
A
Right and left mid-clavicular
Transtubercular
Subcostal
5
Q
What is within the right hypochondriac region?
A
Liver
Gall bladder
6
Q
What is within the epigastric region?
A
Stomach
Liver
Oesophagus
(Transverse colon)
7
Q
What is within the left hypochondriac region?
A
Spleen
Pancreas
8
Q
What is within the right lumbar region?
A
Ascending colon
Small intestine
Right kidney
Gall bladder
9
Q
What is within the umbilical region?
A
Small intestine
10
Q
What is within the left lumbar region?
A
Descending colon
Small intestine
Left kidney
11
Q
What is within the right iliac fossa region?
A
Caecum
Appendix
Small intestine
12
Q
What is within the suprapubic region?
A
Small intestine
Rectum
Sigmoid colon
13
Q
What is within the left iliac fossa region?
A
Small intestine
Descending colon
Sigmoid colon
14
Q
What are the abdominal wall muscles?
A
External oblique
Internal oblique
Rectus abdominis
Transversus abdominis
15
Q
What is the action and innervation of the external oblique muscles?
A
Compress and support abdominal viscera, flex/rotate trunk
Anterior rami T7-11 and subcostal nerve
16
Q
What is the action and innervation of the internal oblique muscles?
A
Compress and support abdominal viscera, flex/rotate trunk
Anterior rami T7-11, subcostal nerve, 1st lumbar
17
Q
What is the action and innervation of the transversus abdominis muscles?
A
Compress and support abdominal viscera
Anterior rami T7-11, subcostal nerve, 1st lumbar
18
Q
What is the action and innervation of the rectus abdominis muscles?
A
Flexes trunk and compresses abdominal viscera, controls tilt of pelvis
Anterior rami T7-11 and subcostal nerve
19
Q
What is the difference in arrangement of abdominal muscles above and below the level of the umbilicus?
A
Above the umbilicus the rectus sheath is incomplete whereas below it is complete
20
Q
Which additional muscle exists in vertical orientation anteriorly in the abdomen? What is it’s action?
A
Pyramidalis - lies in rectus sheath, anterior to inferior rectus abdominis
Tenses linea alba
21
Q
What is the rectus sheath? What is it made up of?
A
An aponeurosis which encloses the rectus abdominis
Made of aponeuroses of;
- internal oblique
- external oblique
- transversus abdominis
22
Q
What is an aponeurosis?
A
thin, fibrous structure attaching muscles to bone or cartilage
23
Q
What thoracic spinal segments innervate the anterior abdominal wall?
A
Anterior rami T7-11 and subcostal nerve
24
Q
How does the inguinal canal form?
A
It forms during relocation of the gonads during foetal development. It is formed from layers of the anterior abdominal wall as they push through the wall obliquely forming a canal.
25
Which bony points does the inguinal canal attach to?
Anterior superior iliac crest and the pubic tubercle (~4cm long)
26
Name the walls, roof and floor of the inguinal canal
Anterior wall; external oblique aponeurosis
Posterior wall; transversalis fascia
Roof; musculo-aponeurotic arches (internal oblique and transvesalis)
Floor; inguinal ligament
27
What are the openings for the inguinal canal?
Deep inguinal ring (superiorly)
| Superficial inguinal ring (inferiorly)
28
What are the superior and inferior epigastric vessels branches of?
Superiorly; internal thoracic artery and vein
| Inferiorly; external iliac artery and vein
29
What are the contents of the inguinal canal?
MALE; spermatic cord, blood and lymphatic vessels, ilio-inguinal nerve
FEMALE; round ligament of uterus, blood and lymphatic vessels, ilio-inguinal nerve
30
What are the histological layers of the gut (from oesophagus to anus)?
Mucosa; epithelium, lamina propria, muscularis mucosae
Submucosa
Muscularis Propria
Serosa/Adventitia
31
What are the basic mucosal types in the GI tract?
Protective - oral cavity, pharynx, oesophagus, anal canal
Secretory - stomach ONLY
Absorptive - entire small intestine
Absorptive/Protective - entire large intestine
32
What are the subdivisions of peritoneum?
Parietal and visceral
33
What are the divisions of the peritoneum? through what do these communicate?
Greater sac and lesser sac
Epiploic foramen (posterior to free edge of lesser omentum)
34
What is the meaning of intraperitoneal and retroperitoneal?
Intraperitoneal - completely surrounded by visceral peritoneum
Retroperitoneal - firmy attached to posterior wall i.e. only anterior surface covered in visceral peritoneum
35
What are some intraperitoneal and retroperitoneal organs?
Intraperitoneal - stomach, spleen, liver, transverse and sigmoid colon
Retroperitoneal - duodenum, kidneys, pancreas, ascending and descending colon
36
What is present in the peritoneal cavity?
Peritoneal fluid (NO ORGANS)
37
Which layer of peritoneum is more sensitive to pressure, pain, heat and cold?
Parietal
38
What are the attachments of the greater and lesser omenta?
Greater; greater curvature of stomach to transverse colon
Lesser; lesser curvature of stomach to liver
39
What is pain in parietal and visceral peritoneum innervated by?
Parietal innervated by T7-12 and L1, so pain is somatic and can be precisely localised
Visceral innervated by autonomic nerves so pain is often referred, dull and poorly localised (PAIN REFERRED TO MIDLINE)
40
What are the posterior abdominal wall muscles and their attachments?
Psoas major - T12, L1-5 vertebrae then enters thigh
Psoas minor - overlies psoas major and gives way to long narrow tendon
Iliacus - fan shaped, upper portion of abdominal surface of ileum, inner side of thigh bone; lesser trochanter
Quadratus lumborum - posterior border of iliac crest, twelfth rib
41
What is the function and innervation of Psoas major?
Flexion and medial rotation of the hip joint, flexes lumbar spine both anteriorly and laterally
Anterior rami of upper lumbar nerves
42
What is the function and innervation of the iliacus muscle?
Assists psoas major in flexing hip joint
Femoral nerve
43
What is the function and innervation of quadratus lumborum?
Lateral flexion of lumbar spine
Subcostal nerve and anterior rami of upper 3 lumbar nerves
44
What is the arcuate line?
The demarcation of the lower limit of the rectus abdominis muscle
45
What are the 3 openings in the diaphragm?
T8 - caval
T10 - oesophageal
T12 - aortic
46
What are the 3 main branches of the abdominal aorta supplying blood to gut tube and at what vertebral level do these occur?
Coeliac trunk - T12
SMA - L1
IMA - L3
47
How does the IVC form in the abdomen?
By the union of the common iliac veins
48
What are the foregut structures?
Abdominal oesophagus
Duodenum
Stomach
49
What are the midgut structures?
```
Jejunum
Ileum
Ascending colon
2/3 transverse colon
(part of duodenum)
```
50
What are the hindgut structures?
1/3 transverse colon
Descending colon
End of transverse colon
Sigmoid colon
51
Which vessels supply foregut, midgut and hindgut?
Foregut; coeliac
Midgut; SMA
Hindgut; IMA
52
What forms the portal vein?
The union of the splenic vein and the SMV
53
What are the sites of portocaval anastomoses in the body? What is the clinical significance of these?
Distal oesophagus
Between rectal veins
Paraumbilical veins
Bare area of liver
Clinical significance; allow portal venous system to communicate with systemic venous system
54
What is the sympathetic neural supply to the abdominal viscera?
Abdominopelvic splanchnic nerves (greater, lesser and least)
Prevertebral sympathetic ganglia
Abdominal aortic plexuses
55
What is the parasympathetic neural supply to the abdominal viscera?
Anterior and posterior vagal trunks
Pelvic splanchnic nerves (S2, S3, S4)
56
Effect of nervous system on
a) GI secretion
b) peristalsis/GI motility
c) blood vessels
Parasympathetic a) stimulates
b) stimulates
c) vasodilation
Sympathetic a) inhibits
b) inhibits
c) vasoconstriction
57
What effect does vagotomy have on gastric secretion?
Reduces gastric secretion as the vagus nerve would be parasympathetic and thus would normally stimulate gastric secretion
58
Functional difference between greater, lesser and least splanchnic nerves and the pelvic splanchnic nerves
Greater, lesser and least are sympathetic
Pelvic are parasympathetic
59
At what level do the kidneys lie?
T12-L3
60
What are the three main structures leaving the hilum of the kidney (in their anterior to posterior arrangement)?
Renal vein
Renal artery
Ureter
61
Where are the suprarenal (adrenal) glands located and what type of gland are they?
Between superomedial aspect of kidneys and diaphragmatic crura
Endocrine (into bloodstream)
62
What is the expanded upper part of the ureter?
Renal pelvis
63
Where is the ureter constricted?
- at junctions of ureters and renal pelvis
- where ureters cross rim of pelvic inlet
- during passage through urinary bladder wall
64
What is the blood supply, venous drainage and lymphatic drainage of the oesophagus?
Blood supply; branches of left gastric artery
Venous drainage; portal system and azygous vein to systemic system
Lymphatic drainage; drain into deep cervical nodes and superior and posterior mediastinal nodes
65
What are the parts of the stomach?
```
cardia
fundus
body
antrum
pylorus
```
66
What is the pyloric sphincter and what is its function?
band of muscle surrounding the exit from stomach to duodenum
acts as a 'valve' to control flow of partially digested food into small intestine
67
In what portions of the stomach are rugae most apparent?
Body and antrum
68
What structures does the stomach lie on?
```
Left dome diaphragm
Pancreas
Spleen
Left kidney
Left suprarenal gland
Colon
Transverse mesocolon
```
69
What are the three parts of the small intestine?
Duodenum
Jejunum
Ileum
70
What is the ampulla of Vater?
the opening of the bile duct and pancreatic duct into the duodenum at the major duodenal papilla
71
In which part of the small intestine are there many arterial arcades?
Ileum
72
What are some important features of large intestine?
Teniae coli and haustra
| Omental appendices
73
Which two structures open into the cavity of the caecum?
Ileum and appendix
74
What is McBurney's point and why is it useful clinically?
Right side of abdomen, 1/3 distance from anterior superior iliac spine and navel
Most common location of appendix
75
What is the arterial supply and venous drainage of the superior, middle and inferior rectum?
Superior - superior rectal artery and vein
Middle - middle rectal artery and vein
Inferior - inferior rectal artery and vein
76
How is the rectum peritonised?
Inferior 1/3 is extraperitoneal, rest is retroperitoneal
77
What is the difference between the visceral and somatic innervation of anal canal?
Visceral - sensitive to stretching
Somatic - sensitive to pain
78
What is the falciform ligament and what structures lie within its free border?
Ligament attaching liver to body wall - ligamentum teres (round ligament)
79
What is the round ligament a remnant of?
Umbilical vein
80
What are the paracolic gutters?
spaces between colon and abdominal wall
81
What kind of epithelium lines the oesophagus?
stratified squamous non-keratinised epithelium
82
What secretory cells are present in the gastric pits?
mucous secreting cells - secrete mucus
Parietal cells - HCl and intrinsic factor
Chief cells - pepsinogens
83
What are the folds extending into the small intestine called?
Plicae circulares
84
What kind of surface epithelium do villi have?
Simple columnar
85
What is the transpyloric plane? What structures are present in this plane?
plane halfway between suprasternal notch of manubrium and upper border of symphysis pubis
first part of duodenum, neck of pancreas, kidneys (hila), spleen (hilum)
86
Which organ is examined in
a) barium meal
b) barium meal follow through
c) Barium enema
a) stomach
b) small intestine
c) large intestine and rectum
87
What is the spleen and what is its function?
A lymphoid organ connected to the blood vascular system
It acts as a filter for blood and plays an important role in the immune responses of the body
88
What are the areas of the spleen?
Gastric
Renal
Colic
Pancreatic
89
How is spleen peritonised?
Intraperitoneal
90
What are the structures in the hilum of the spleen?
Splenic artery
Splenic vein
Gastrosplenic ligament
Lymphatics
91
How is the pancreas peritonised?
Retroperitoneal
92
What are the parts of the liver?
Right and left lobes separated by falciform ligament
Caudate (superior) and quadrate (inferior) lobes
Left triangular ligament
Bare area lacking peritoneum
93
What is the bare area of the liver?
Triangular area on diaphragmatic surface that is not peritonised
94
What structures are present in the porta hepatis?
Portal vein
Left and right hepatic ducts
Left and right branches of hepatic artery
95
What are the extrahepatic biliary apparatus?
```
Right and left hepatic ducts
Common hepatic duct
Cystic duct
Gall bladder
Common bile duct
```
96
What is the function of bile?
To dissolve fat and fat soluble vitamins
97
What are the boundaries of Calot's Cystohepatic triangle and what is its clinical significance?
Cystic duct, common hepatic duct and inferior surface of liver
Care must be taken during cholecystectomy (gall bladder removal) because the triangle contains the cystic artery. It is important not to damage structures in and around the triangle.
98
What is the surface marking of the gall bladder?
9th costal cartilage
99
What ribs are related to the spleen?
9, 10 and 11
100
Describe the obturator nerve
Originates from posterior divisions of L2, L3 and L4 spinal roots
travels medially along psoas major before entering obturator foramen (opening in pelvic bone) and passing into thigh
101
What is the cysterna chyli?
A dilated sac at the lower end of thoracic duct into which lymph from intestinal trunk and two lumbar lymphatic trunks flows.
It passes through aortic hiatus (T12) in diaphragm.
102
What is the clinical significance of the paracolic gutters?
Infected fluid can spread through these to other parts of the abdomen
103
What is the lymphatic drainage of the stomach?
Suprapyloric lymph nodes
Inferior gastric subpyloric lymph nodes
Superior gastric lymph nodes
Pancreaticolineal lymph nodes
104
What is the lymphatic drainage of the first part of the duodenum?
Celiac group of lymph nodes
105
What is the lymphatic drainage of the second part of duodenum?
Pancreato-duodenal lymph nodes
106
What is the lymphatic drainage of the jejunum and ileum?
Superior mesenteric group of lymph nodes
107
What is the lymphatic drainage of the cecum and ascending colon?
Superior mesenteric group of lymph nodes
108
What is the lymphatic drainage of the right 2/3rds of the transverse colon?
Superior mesenteric group of lymph nodes
109
What is the lymphatic drainage of the left 1/3rd of the transverse colon?
Inferior mesenteric group of lymph nodes
110
What is the lymphatic drainage of the sigmoid colon?
Inferior mesenteric group of lymph nodes
111
Where is epiploic foramen in relation to the portal vein?
Posterior
112
Where does the spleen develop?
Dorsal mesogastrium
113
Where does part of the motor supply to the diaphragm come from?
Phrenic and lower intercostal nerves
114
What are the kidneys embedded in?
Perirenal fat
115
What is some of the skin of the scrotum supplied by?
Ilioinguinal nerve
116
What vertebral level does the body of the pancreas lie at?
First lumbar vertebra
*receives branches from splenic artery
117
What are some direct relations to the abdominal aorta?
- left renal vein
- anterior longitudinal ligament
- left lumbar veins
118
What peritoneum is related to the liver?
- falciform ligament
- left and right triangular ligaments
- lesser omentum
- hepatorenal recess
119
What innervates psoas major?
upper lumbar nerves L1-3 anterior rami
120
Innervation of liver
Hepatic neural plexus
- sympathetic fibres from coeliac plexus
- parasympathetic fibres from anterior and posterior vagal trunks
121
Innervation of pancreas
Vagus nerve
| Thoracic splanchnic nerve fibres from superior mesenteric and coeliac plexuses
122
Innervation of stomach
Sympathetic from coeliac ganglion and splanchnic nerves supply blood vessels and musculature
Parasympathetic travel in gastric branches of vagus
123
Kupffer cells
Specialised liver macrophages, lining walls of sinusoids
Form part of mononuclear phagocyte system, constitute 80-90% macrophages in the body
